Your Doctor’s Bedside Manner

Does warm and fuzzy beat out cutting edge in doctor-patient relationships?

By Mary Anne Dunkin

They say talk is cheap. But if you’re dealing with a difficult diagnosis or chronic condition like arthritis, you may have found that a doctor’s good bedside manner and her ability to talk respectfully and, perhaps more importantly, listen empathetically, is among her most valuable assets. If so, you’re not alone.

In a 2005 Harris Interactive poll, 84 percent of respondents said it was extremely important that their doctor was “easy to talk to.” An earlier Harris poll found patients were more concerned that their doctors listened to them than whether or not they were up to date on the latest medical technology and research.

David Fritz, MD, for one, isn’t surprised by the findings. “I think [patients] assume that the doctor has a minimum skill set or they wouldn’t be a doctor – and now that we have the Internet, a doctor who doesn’t have the answer can look it up right away,” he says. “So I don’t think it’s as much a matter of ‘does my doctor know what’s going on?’ as it is ‘does my doctor care about me? And if they do care about me, they will do a better job, even if they don’t have the answer right now.’”

Dr. Fritz graduated this May from the University of South Florida (USF) College of Medicine in Tampa, a school that focuses on what he calls, the “touchy-feely” aspects of medicine, as well as the technical skills to be a good physician.

At several points through his training, Dr. Fritz says he and his classmates were engaged in role-playing situations with representatives from the University’s School of Mass Communications and were videotaped and evaluated on their communication skills. At the end of each block (a section which focused on a certain area of medicine, such as musculoskeletal diseases or nervous system disorders, for example) part of the exam would be a simulated patient encounter in which the students were evaluated on such skills as politeness and the ability to communicate in language the patient can understand, he says.

But USF is far from the only school to focus on these less technical aspects of practicing medicine. In recent years, coursework in interpersonal skills, more commonly know as bedside manner, has become standard for almost every U.S. medical school. Throughout the country, medical schools, including University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School and the Mayo Clinic are using instructional videos and professional actors playing the role of patients with a wide range of personalities and illnesses to teach bedside manner.

At the Medical College of Ohio in Toledo, the largest individual gift in the college’s history – $1.9 million – came with the stipulation that it be used to teach bedside manner. The result: The Ruth Hillebrand Clinical Skills Center, funded with a gift from the estate of a New York psychologist who had been treated rudely by doctors, was dedicated in 2005. Since then, the center has been helping medical students brush up on their bedside manner.

They say talk is cheap. But if you’re dealing with a difficult diagnosis or chronic condition like arthritis, you may have found that a doctor’s good bedside manner and her ability to talk respectfully and, perhaps more importantly, listen empathetically, is among her most valuable assets. If so, you’re not alone.

In a 2005 Harris Interactive poll, 84 percent of respondents said it was extremely important that their doctor was “easy to talk to.” An earlier Harris poll found patients were more concerned that their doctors listened to them than whether or not they were up to date on the latest medical technology and research.

David Fritz, MD, for one, isn’t surprised by the findings. “I think [patients] assume that the doctor has a minimum skill set or they wouldn’t be a doctor – and now that we have the Internet, a doctor who doesn’t have the answer can look it up right away,” he says. “So I don’t think it’s as much a matter of ‘does my doctor know what’s going on?’ as it is ‘does my doctor care about me? And if they do care about me, they will do a better job, even if they don’t have the answer right now.’”

Dr. Fritz graduated this May from the University of South Florida (USF) College of Medicine in Tampa, a school that focuses on what he calls, the “touchy-feely” aspects of medicine, as well as the technical skills to be a good physician.

At several points through his training, Dr. Fritz says he and his classmates were engaged in role-playing situations with representatives from the University’s School of Mass Communications and were videotaped and evaluated on their communication skills. At the end of each block (a section which focused on a certain area of medicine, such as musculoskeletal diseases or nervous system disorders, for example) part of the exam would be a simulated patient encounter in which the students were evaluated on such skills as politeness and the ability to communicate in language the patient can understand, he says.

But USF is far from the only school to focus on these less technical aspects of practicing medicine. In recent years, coursework in interpersonal skills, more commonly know as bedside manner, has become standard for almost every U.S. medical school. Throughout the country, medical schools, including University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School and the Mayo Clinic are using instructional videos and professional actors playing the role of patients with a wide range of personalities and illnesses to teach bedside manner.

At the Medical College of Ohio in Toledo, the largest individual gift in the college’s history – $1.9 million – came with the stipulation that it be used to teach bedside manner. The result: The Ruth Hillebrand Clinical Skills Center, funded with a gift from the estate of a New York psychologist who had been treated rudely by doctors, was dedicated in 2005. Since then, the center has been helping medical students brush up on their bedside manner.

“Some people have these skills naturally, but not everyone does,” says Daniel Duffy, MD, senior associate dean for academic programs at the University of Oklahoma School of Community Medicine in Tulsa and former executive vice president of the American Board of Internal Medicine. “They are skills that can be taught.”

For students who don’t come by the skills naturally, learning them in medical school is critical, because since 2004, medical students have had to pass a test of communications and interpersonal skills to graduate. If the doctor specializes in internal medicine, pediatrics, family medicine or many other fields, he or she must pass another evaluation to be able to sit for the examination by the specialty board, says Dr. Duffy.

Proponents say learning these skills does more than lead to a medical degree, certification and warm and fuzzy feelings from patients – it also makes doctors more effective as doctors.

In a 2001 study published in The Lancet, doctors in Europe concluded that “practitioners who attempted to form a warm and friendly relationship with their patients were found to be more effective than practitioners who kept their consultations impersonal, formal or uncertain.”

The study, which analyzed 25 surveys concerning doctor-patient relationships, consistently found that doctors with good bedside manners had a better impact on patients than less personal doctors.

A separate study reported in the journal Mayo Clinic Proceedings found that when patients were asked to describe their best and worst experiences with doctors, they rarely even mentioned the doctor’s technical expertise. Instead their issues – good or bad – tended to focus on doctors’ personalities. They used adjectives such as “honest,” “compassionate” and “respectful” to described good doctors, and words such as “arrogant” and “callous” to describe bad doctors.

Other studies have had similar findings. Analyzing data from four clinical trials conducted in practice settings with diverse patients, doctors at New England Medical Center’s Institute for the Improvement of Medical Care and Health in Boston found that better health, (measured by blood pressure or blood sugar, functional status, or subjective evaluations of overall health status) was consistently related to the quality of the doctor-patient relationship. And, in New Zealand, doctors who surveyed 370 patients in doctors’ office waiting rooms found that those who reported a good relationship with their doctor were one-third more likely to be taking their prescription medication than those who gave their relationship with their doctor lower ratings.

“The way doctors interact with patients, interview patients, tell patients information – all of these things are critically important to the patient setting, critically important to making a correct diagnosis, critically important to lowering the patient’s anxiety level by demonstrating competence and confidence,” says Dr. Duffy. “That’s essential to patients’ well-being and security.”